Individual
DUANE FOWLKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(880) 486-8879
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603795
VA
Other
Enumeration date
06/11/2014
Last updated
10/22/2015
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